DOI: 10.1542/peds.

2008-2139KK
2008;122;S194 Pediatrics
Faith Huang and Anna Nowak-Wegrzyn
Drug Allergy Claims in Children: From Self-reporting to Confirmed Diagnosis

http://pediatrics.aappublications.org/content/122/Supplement_4/S194.1
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of Pediatrics. All rights reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275.
Boulevard, Elk Grove Village, Illinois, 60007. Copyright 2008 by the American Academy
published, and trademarked by the American Academy of Pediatrics, 141 Northwest Point
publication, it has been published continuously since 1948. PEDIATRICS is owned,
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PAF levels increased from 4% in the control groups to
20% in the group with grade 1 anaphylaxis, 71% in the
group with grade 2 anaphylaxis, and 100% in the group
with grade 3 anaphylaxis. There was an inverse correla-
tion between PAF levels and serum PAF acetylhydrolase
activity. The proportion of patients with low PAF acetyl-
hydrolase activity increased with the severity of anaphy-
laxis. Serum PAF acetylhydrolase activity was signi-
cantly lower in patients with fatal peanut anaphylaxis
than in control patients.
CONCLUSIONS. Serum PAF levels were directly correlated
and serum PAF acetylhydrolase activity was inversely
correlated with the severity of anaphylaxis. PAF acetyl-
hydrolase activity was signicantly lower in patients
with fatal anaphylactic reactions to peanuts than in pa-
tients in any of the control groups. Failure of PAF acetyl-
hydrolase to inactivate PAF may contribute to the sever-
ity of anaphylaxis.
REVIEWER COMMENTS. PAF is 1 of the proinammatory medi-
ators that are released systemically by the degranulation
of mast cells and basophils. Although PAF is not the only
mediator that plays a role in anaphylaxis, these results
suggest that PAF is very important. Therefore, it may be
useful to develop new pharmaceutical agents that block
its actions. Additional research is also needed to deter-
mine if PAF and PAF acetylhydrolase measurements
may be used as a screening tool to select patients at
highest risk for fatal anaphylaxis.
URL: www.pediatrics.org/cgi/doi/10.1542/peds.2008-2139JJ
Brian A. Smart, MD, FAAP
Glen Ellyn, IL
DRUG HYPERSENSITIVITY
Drug Allergy Claims in Children: From Self-
reporting to Conrmed Diagnosis
Rebelo Gomes E, Fonseca J, Araujo L, Demoly P. Clin
Exp Allergy. 2008;38(1):191198
PURPOSE OF THE STUDY. To assess the prevalence of self-re-
ported adverse drug reactions and drug allergy in a pe-
diatric population and conrm the diagnosis in children
with suspected drug allergy.
STUDY POPULATION. Patients (n 1426) responded to an
initial cross-sectional survey. A total of 60 of 67 patients
with reported drug allergy were evaluated at an allergy
clinic.
METHODS. The rst phase included a cross-sectional survey
that assessed the life occurrence of adverse drug reac-
tions and self-reported drug allergy in the outpatient
clinic of a pediatric hospital. The second phase involved
a diagnostic workup in children with parent-reported
drug allergy, including detailed clinical history and in
vitro and in vivo investigations. Specic immunoglobu-
lin E (IgE) level determination for -lactams, prick and
intradermal skin testing for -lactams, local anesthetics
and sulfonamides, and patch tests (if a delayed reaction
was reported) were performed. If all other investigations
were inconclusive and a provocation test was not con-
traindicated, this test was performed.
RESULTS. The prevalence of self-reported adverse drug re-
actions and drug allergy were 10.2% and 6.0%, respec-
tively. The frequency of a medical diagnosis of drug
allergy was 3.9%. The majority of the suspected allergic
reactions were nonimmediate cutaneous events attrib-
uted to -lactam antibiotics in younger children. Of 60
patients evaluated in the allergy clinic, 39 patients had a
plausible clinical history, and additional investigation
including a skin test, IgE-level measurement, and possi-
ble provocation tests were conducted. Drug allergy was
diagnosed in 3 children on the basis of positive responses
in skin (n 1) and oral provocation (n 2) tests.
CONCLUSIONS. Although adverse drug reactions and sus-
pected drug allergy are frequently reported in children,
after a complete evaluation, only a few of these reactions
can be attributed to immediate and nonimmediate drug
allergy. Overall, 94% of the patients could tolerate the
initially suspected drug.
REVIEWER COMMENTS. This study underscores a serious prob-
lem: patients who experience or perceive a drug reaction
are often classied as being truly allergic when this may
not be the case. Such overdiagnosis and misdiagnosis
may result in suboptimal medication choices. These re-
sults show that only 6% of the patients with initially
suspected drug allergy were truly allergic. This study
demonstrates the importance of a complete and detailed
history, with consideration of additional testing includ-
ing skin-prick tests, specic IgE-level determination, and
provocation tests. It should be noted that for nonimme-
diate drug allergy, an oral provocation test may require
prolonged treatment to observe for symptoms. Such
provocation tests would not be undertaken for severe
previous reactions (eg, toxic epidermal necrolysis).
URL: www.pediatrics.org/cgi/doi/10.1542/peds.2008-2139KK
Faith Huang, MD
Anna Nowak-Wegrzyn, MD
New York, NY
HLA-B*5701 Screening for Hypersensitivity to
Abacavir
Mallal S, Phillips E, Carosi G, et al. N Engl J Med. 2008;
358(6):568579
PURPOSE OF THE STUDY. Abacavir is associated with severe and
potentially life-threatening hypersensitivity reactions in
up to 8% of the white population. In 2002, HLA-B*5701
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DOI: 10.1542/peds.2008-2139KK
2008;122;S194 Pediatrics
Faith Huang and Anna Nowak-Wegrzyn
Drug Allergy Claims in Children: From Self-reporting to Confirmed Diagnosis

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Grove Village, Illinois, 60007. Copyright 2008 by the American Academy of Pediatrics. All
and trademarked by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk
publication, it has been published continuously since 1948. PEDIATRICS is owned, published,
PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly
at Indonesia:AAP Sponsored on May 30, 2014 pediatrics.aappublications.org Downloaded from